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Diverticulitis Alternatives

October 8, 2010 Written by JP       [Font too small?]

Are you familiar with a medical condition known as diverticulitis? The answer to this question likely depends on your age. Adults over the age of 50 are far more likely to have an intimate awareness of this inflammatory condition that affects the inner lining of the intestines. In fact, it’s estimated that as many as 50% of seniors will deal with one complication or another associated with the swelling of sacs (diverticula) in the intestinal wall or diverticulitis. Potential symptoms include abdominal pain, chills, fever, nausea, vomiting and weight loss. As with most health care matters, preventing the development of this disease is preferred over treating it.

Conventional treatments for diverticular disease range from antibiotic therapy to surgery in severe cases. But what I want to concentrate on today is a growing body of research that is focusing on how to reduce the risk of diverticulitis in the first place. (1,2)

Ensuring adequate to optimal levels of fiber in your diet is the best documented way of reducing the likelihood of diverticular issues. Historical and population-based data has consistently revealed that this disease was “virtually unknown before the adoption of a westernized diet, low in fiber”. What’s more, it appears that both insoluble and soluble fiber have a role to play. Insoluble fiber was originally believed to be the primary dietary component responsible for preventing diverticular disease by supporting healthy elimination. However, soluble fiber has recently gained some attention. This is largely due its ability to positively influence intestinal flora which is thought to contribute to the secondary prevention of diverticulitis. (3,4,5,6)

  • Good Sources of Insoluble Fiber: avocado, brussels sprouts, cabbage, flax seeds and nuts
  • Good Sources of Soluble Fiber: berries, broccoli, chia seeds, cocoa and psyillium husks

Probiotics may offer both preventive and therapeutic activity in patients with diverticular disease. So far, three trials have been published in the medical literature. Two of the three have combined the use of a specific “high potency probiotic mixture” (VSL #3) and a prescription medication typically used to control intestinal inflammation (Balsalazide). The conclusion of the studies state that the “combination probiotic/anti-inflammatory drug was found better than probiotic treatment in preventing relapse of uncomplicated diverticulitis of the colon”. A third trial compared the efficacy of a different anti-inflammatory medication (Mesalazine) alone or in concert with a solitary probiotic, Lactobacillus casei DG. L. casei DG alone or in combination with Mesalazine demonstrated a highly relevant reduction of diverticular symptoms. These findings are based on an examination involving 71 patients over a 24 month period. By the study’s end, 88% of the participants “were symptom-free”. It’s also interesting to note that four patients dropped out of the trial. Every single one of the drop-outs had a recurrence of symptoms. (7,8,9)

Several studies point to vigorous physical activity as contributing to intestinal health. Most recently, a 2009 investigation involving over 10,000 participants found that men and women who ran regularly had a 70% lower risk of the diverticular disease as compared to infrequent runners. An even larger study from that same year, which analyzed the physical activity of over 47,000 men over an 18 year follow up period, demonstrated a 34% risk reduction in men with the highest vs. lowest levels of vigorous exercise. Much like the data on fiber, an active lifestyle is now considered a first-line approach in preventing diverticulitis. (10,11,12)

The Prevalence of Diverticulitis Among Different Age Groups
Source: World J Gastroenterol. 2009 May 28; 15(20): 2479–2488. (link)

There are also a few experimental options that I think are worth considering, among them, an amino acid named glutamine. Glutamine has never been clinically studied in patients with diverticulitis. But preliminary research in animal models of GI diseases suggests a possible role for this nutritional supplement in supporting intestinal integrity. A new study appearing in the European Journal of Pharmacology notes that supplementing the diet of rats with glutamine powder can attenuate experimentally-induced inflammation and intestinal injury. More support comes in the form of a 2009 publication in the American Journal of Clinical Nutrition which reports that glutamine plays a vital role in nourishing the epithelial cells of the large and small intestines. Finally, a Scandinavian review from all the way back in 1996 points to “fiber, resistant starch, short-chain fatty acids, glutamine and fish oils” as natural therapeutic candidates for the prevention of “gastrointestinal diseases such as diverticulitis, diversion colitis, ulcerative colitis” and beyond. (13,14,15,16,17)

From a dietary and/or supplemental perspective, one could make a case for the inclusion of fish and turmeric. The predominant fatty acids found in fish (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) and the curcuminoids contained in tumeric appear to mediate pro-inflammatory cytokines in the intestines. An example of the proposed impact of such ingredients can be found in scientific paper published in 2005. The trial in question examined the effects of a combination of antioxidants, fiber, fish oil and prebiotics in a group of patients with ulcerative colitis. This blend of “nutraceuticals” reduced the patients dependence on prednisone, a potent corticosteroid. Diverticulitis and ulcerative colitis are by no means identical. However, they are both gastrointestinal diseases which are conventionally managed using powerful anti-inflammatory medications that carry the risk of serious side effects. (18,19,20,21,22)

In closing, I’d like to dispel the notion that avoiding foods such as corn, nuts and seeds is necessary if you’re concerned about diverticulitis. This piece of advice is intended to prevent the possibility of jagged particles of said foods causing irritation or even bleeding by making contact with the swelling sacs or diverticula. This may be a remote issue for those with established diverticulitis. The best remedy, in this instance, is to simply chew these foods thoroughly. What’s even more important to note is that those without diagnosed diverticulitis do not appear at greater risk for developing the disease if they consume this group of foods. This concern was put to rest in a landmark study published in the August 2008 issue of the Journal of the American Medical Association. If anything, the evidence presented there revealed an unexpected protective effect – 20% reduced risk for nuts and an 18% reduced risk for popcorn. So by all means, include nuts and seeds in your diet if you enjoy them. And while you’re at, why not walk to store to buy them? The combination of staying physically active and eating plenty of fiber-rich, whole foods may just be your ticket to staying diverticulitis-free. (23,24)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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17 Comments & Updates to “Diverticulitis Alternatives”

  1. Sue Says:

    When most people are told to increase fibre do you think they go for the wheat bran rather than vegies. Do you think wheat bran is too rough and actually contributes to some conditions in the GIT?

    Why is there a risk reduction of diverticulitis with running – is it the actual running (vigorous), any physical activity, the health behaviours of runners – eat better, healthier lifestyle?

  2. Paul F. Says:

    Hi JP,

    Great battery of recommendations for the prevention od diverticulitis!

    I belong to the age group more propense to develop diverticulitis, so I intend to follow the recommendations you were able to research.

  3. Paul F. Says:


    Thank you for me and many 70+ friends that could be targets of this nuissance!

    Paul

  4. anne h Says:

    Sometimes, “old school” nurses give a cocktail of sorts:
    Hot coffee with hot prune juice, and melted butter in it!
    Good results, every time!

  5. JP Says:

    Sue,

    I don’t think wheat bran is a very good option. Wheat is a known allergen for many and make contribute to permeability of the intestinal wall.

    http://www.healthyfellow.com/659/dr-loren-cordain-interview-part-two

    In general, I would focus on grain-free fiber sources such as low-glycemic fruits, nuts, seeds and non-starchy vegetables.

    Physical activity may help in a number of ways. Among them, it improves circulation throughout our system and supports normal peristalsis.

    Be well!

    JP

  6. JP Says:

    Thank you very much, Paul! Much appreciated! :)

    Be well!

    JP

  7. JP Says:

    I believe it, Anne! I can see how that would get the job done! You nurses know all the tricks! ;)

    Be well!

    JP

  8. Nina K. Says:

    Wow, the “hot coffee” cocktail sound very tasty and effective ☺

    Just detected this blog: http://coolinginflammation.blogspot.com/

    Interesting info about gut, microflora in the gut, obstipation etc. …really interesting ☺

    Greetings,
    Nina K.

  9. JP Says:

    Thank you, Nina! I shall re-visit the site! Chronic inflammation is an important consideration to be sure. :)

    Be well!

    JP

  10. Nina K. Says:

    Good morning, JP :-)

    the site i mentioned obove is really informative: the professor says, that obstipation and related diseases can be caused by the microbiological gut flora. a hughe amount of what “comes out” is made of bacteria and biofilm (produced by bacteria), so its important to influence the gut flora in a good low carb way. eating to much fiber will worsen the situation.

    I recommend to read his comments under the articles, really very interesting :-)

    stay healthy :-)
    Nina K.

  11. JP Says:

    Nina,

    Sounds interesting. I’ll look for that specific information as soon as I have a few free moments. Thank you for bringing it to my attention. :)

    Be well!

    JP

  12. Scott Carmack Says:

    Yes, Nina’s point is echoed by a research pharmacist in this website as well. That too much fiber is toxic as well. Very interesting read with tons of information.

    http://www.gutsense.org/gutsense/flora.html

  13. JP Says:

    Update 06/11/15:

    http://www.arcmedres.com/article/S0188-4409(15)00122-8/abstract

    Arch Med Res. 2015 May 19.

    Anti-Inflammatory Effects of Resveratrol in Patients with Ulcerative Colitis: A Randomized, Double-Blind, Placebo-controlled Pilot Study.

    BACKGROUND AND AIMS: Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease in which reducing pro-inflammatory and/or increasing anti-inflammatory molecules is the mainstay of treatment. The aim of this study was to evaluate the effects of supplementation with resveratrol as an antiinflammatory and antioxidant agent on inflammation and quality of life in patients with active UC.

    METHODS AND RESULTS: In this randomized, double-blind, placebo-controlled study, 50 eligible patients with active mild to moderate UC were supplemented with either a 500-mg resveratrol or placebo capsule for 6 weeks. Serum inflammatory markers, activity of NF-κB in peripheral blood mononuclear cells (PBMC) and quality of life were assessed at baseline and at the end of the study. Resveratrol supplementation led to a significant reduction in plasma levels of TNF-α (19.70 ± 12.80 to 17.20 ± 10.09 pg/mL) and hs-CRP (4764.25 ± 2260.48 to 2584.50 ± 1792.80 ng/mL) and activity of NF-κB in PBMCs (0.19 ± 0.05 to 0.10 ± 0.04 OD) (p < 0.001), whereas there were no significant changes of these factors in placebo group. Also, the score of inflammatory bowel disease questionnaire -9 (IBDQ-9) increased, whereas the clinical colitis activity index score decreased significantly in the resveratrol group (32.72 ± 7.52 to 47.64 ± 8.59) (p < 0.001) and when compared with the placebo group (35.54 ± 9.50 to 41.08 ± 6.59) (p < 0.001).

    CONCLUSION: Our results indicate that 6 weeks supplementation with 500 mg resveratrol can improve quality of life and disease clinical colitis activity at least partially through inflammation reduction in patients with UC. Whether these effects will be continued in longer duration of treatment remains to be determined.

    Be well!

    JP

  14. JP Says:

    Updated 07/26/15:

    http://gut.bmj.com/content/63/9/1450.long

    Gut. 2014 Sep;63(9):1450-6.

    Source of dietary fibre and diverticular disease incidence: a prospective study of UK women.

    BACKGROUND: Previous prospective studies have found the incidence of intestinal diverticular disease decreased with increasing intakes of dietary fibre, but associations by the fibre source are less well characterised. We assessed these associations in a large UK prospective study of middle-aged women.

    METHODS AND FINDINGS: During 6 (SD 1) years follow-up of 690 075 women without known diverticular disease who had not changed their diet in the last 5 years, 17 325 were admitted to hospital or died with diverticular disease. Dietary fibre intake was assessed using a validated 40-item food questionnaire and remeasured 1 year later in 4265 randomly-selected women. Mean total dietary fibre intake at baseline was 13.8 (SD 5.0) g/day, of which 42% came from cereals, 22% from fruits, 19% from vegetables (not potatoes) and 15% from potatoes. The relative risk (95% CI) for diverticular disease per 5 g/day fibre intake was 0.86 (0.84 to 0.88). There was significant heterogeneity by the four main sources of fibre (p<0.0001), with relative risks, adjusted for each of the other sources of dietary fibre of 0.84 (0.81 to 0.88) per 5 g/day for cereal, 0.81 (0.77 to 0.86) per 5 g/day for fruit, 1.03 (0.93 to 1.14) per 5 g/day for vegetable and 1.04 (1.02 to 1.07) per 1 g/day for potato fibre.

    CONCLUSIONS: A higher intake of dietary fibre is associated with a reduced risk of diverticular disease. The associations with diverticular disease appear to vary by fibre source, and the reasons for this variation are unclear.

    Be well!

    JP

  15. JP Says:

    Updated 07/26/15:

    http://medpress.com.pl/pubmed.php?article=226228

    Pol Merkur Lekarski. 2015 Apr;38(226):228-32.

    [Dietary prevention and treatment of diverticular disease of the colon].

    Diverticular disease is more often categorized as a civilization disease that affects both women and men, especially at an old age. The pathophysiology remains complex and arises from the interaction between dietary fiber intake, bowel motility and mucosal changes in the colon. Obesity, smoking, low physical activity, low-fiber diet (poor in vegetables, fruit, whole grain products, seeds and nuts) are among factors that increase the risk for developing diverticular disease. Additionally, the colonic outpouchings may be influenced by involutional changes of the gastrointestinal tract. Therefore, the fiber rich diet (25-40 g/day) plays an important role in prevention, as well as nonpharmacological treatment of uncomplicated diverticular disease. The successful goal of the therapy can be achieved by well-balanced diet or fiber supplements intake. Research indicate the effectiveness of probiotics in dietary management during the remission process. Moreover, drinking of appropriate water amount and excluding from the diet products decreasing colonic transit time – should be also applied.

    Be well!

    JP

  16. JP Says:

    Updated 07/26/15:

    http://onlinelibrary.wiley.com/doi/10.1111/apt.12463/full

    Aliment Pharmacol Ther. 2013 Oct;38(7):741-51.

    Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease–a double-blind, randomised, placebo-controlled study.

    BACKGROUND: Placebo-controlled studies in maintaining remission of symptomatic uncomplicated diverticular disease (SUDD) of the colon are lacking.

    AIM: To assess the effectiveness of mesalazine and/or probiotics in maintaining remission in SUDD.

    METHODS: A multicentre, double-blind, placebo-controlled study was conducted. Two hundred and ten patients were randomly enrolled in a double-blind fashion in four groups: Group M (active mesalazine 1.6 g/day plus Lactobacillus casei subsp. DG placebo), Group L (active Lactobacillus casei subsp. DG 24 billion/day plus mesalazine placebo), Group LM (active Lactobacillus casei subsp. DG 24 billion/day plus active mesalazine), Group P (Lactobacillus casei subsp. DG placebo plus mesalazine placebo). Patients received treatment for 10 days/month for 12 months. Recurrence of SUDD was defined as the reappearance of abdominal pain during follow-up, scored as ≥5 (0: best; 10: worst) for at least 24 consecutive hours.

    RESULTS: Recurrence of SUDD occurred in no (0%) patient in group LM, in 7 (13.7%) patients in group M, in 8 (14.5%) patients in group L and in 23 (46.0%) patients in group P (LM group vs. M group, P = 0.015; LM group vs. L group, P = 0.011; LM group vs. P group, P = 0.000; M group vs. P group, P = 0.000; L group vs. P group, P = 0.000). Acute diverticulitis occurred in six group P cases and in one group L case (P = 0.003).

    CONCLUSION: Both cyclic mesalazine and Lactobacillus casei subsp. DG treatments, particularly when given in combination, appear to be better than placebo for maintaining remission of symptomatic uncomplicated diverticular disease.

    Be well!

    JP

  17. JP Says:

    Updated 07/26/15:

    http://www.minervamedica.it/en/journals/gastroenterologica-dietologica/article.php?cod=R08Y2011N01A0013

    Minerva Gastroenterol Dietol. 2011 Mar;57(1):13-22.

    Efficacy of Lactobacillus paracasei sub. paracasei F19 on abdominal symptoms in patients with symptomatic uncomplicated diverticular disease: a pilot study.

    AIM: The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains to be defined, and only a few studies have tested the efficacy of probiotics in these patients.

    METHODS: Patients with symptomatic uncomplicated DD were randomized to a control arm, i.e., (group A, [N.=16], high-fibre diet alone), or to Group B ([n=18], twice daily 1 sachet of probiotic + high-fibre diet), or group C ([N.=16], twice daily 2 sachets of probiotic + high-fibre diet). The probiotic Genefilus F19© containing Lactobacillus paracasei sub. paracasei F19 was administered for 14 days/month for 6 months. The primary endpoint under consideration was a decrease in abdominal pain and bloating intensity after treatment.

    RESULTS: Bloating decreased significantly in Groups B and C VAS score group B: 4.6 ± 2.6 vs. 2.3 ± 2.0, P<0.05, group C: 3.9 ± 2.9 vs. 1.8 ± 2.1, P<0.05). The decrease in abdominal pain within 24 hours in these groups did not reach statistical significance. During treatment, none of the group B (N.=4) or group C patients (N=3) with abdominal pain >24 hours reported the recurrence of this symptom, while the 3 group A patients reported at least one episode (P=0.016). No significant difference regarding abdominal pain <24 hours and bloating was observed between the two groups of patients treated with a low or high probiotic dose.

    CONCLUSION: Lactobacillus paracasei F19, in association with a high-fibre diet, is effective in reducing abdominal bloating and prolonged abdominal pain in symptomatic uncomplicated diverticular disease, and could thus be a promising option in the treatment of these patients.

    Be well!

    JP

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